More than 50% of nonsurgical patients receive opioid prescriptions

Amid a growing climate of concern regarding the overuse of opioid pain medications, a comprehensive analysis of more than 1 million hospital admissions has found that more than 50% of all nonsurgical patients were prescribed opioids during their hospitalizations — often at very high doses — and that more than half of those exposed were still receiving these medications on the day they were discharged from the hospital.

Led by a research team at Beth Israel Deaconess Medical Center in Boston, the examination of data from 286 hospitals around the U.S. also found widespread regional variation in the use of opioids throughout the country.

The CDC has reported that the rate of fatal overdoses from opioids nearly quadrupled over the last decade, with estimates of more than 14,000 deaths from opioid overdoses annually, according to background information for the study, which was published Nov. 13 on the website of the Journal of Hospital Medicine.

“Realizing that inpatient use might provide a portal to outpatient use, we were interested in looking at how opioids were being used in the hospital setting,” Shoshana J. Herzig, MD, MPH, the study’s first author, a hospitalist in BIDMC’s Division of General Medicine and Primary Care and an instructor in medicine at Harvard Medical School, said in a news release.

The authors analyzed data from a cohort of 1.14 million adult nonsurgical inpatients at 286 non-federal acute-care hospitals between July 1, 2009, and June 30, 2010.

The authors found that 43% of all patients were exposed to multiple opioids during their hospitalization, with the average dose being about 68 milligrams of oral morphine equivalents per day. “That’s a very high dose,” Herzig said.

Of greater concern, she added, their analysis revealed that 23% of all patients received a dose equal to or greater than 100 milligrams on at least one day during their hospitalization. “Patients receiving doses of 100 mg per day or more are at substantially greater risk for serious problems, including severe breathing problems,” Herzig said.

Also of concern, she noted, 26% of all patients received opioids on the day they were discharged from the hospital. “Given that opioids are often tapered off rather than abruptly discontinued, this finding suggests that up to half of these patients were sent home with a prescription for opioid medication,” Herzig said. “Unless physicians are diligent about checking on other opioid prescriptions that a patient may have received in another setting, this means that patients could wind up with multiple opioid prescriptions, thus increasing the likelihood of an inadvertent overdose or other adverse event.”

After the researchers controlled for many different patient characteristics, the findings also revealed distinct regional differences in the use of opioids in nonsurgical inpatients, with a difference in rates of prescribing of 37% between the highest (West) and lowest (Northeast) regions.

The authors also found that patients receiving opioids at hospitals that prescribe them more frequently are at greater risk for serious opioid-related complications than are similar patients receiving opioids at hospitals with more restrictive prescribing. “In other words, hospitals that used these drugs more frequently did so less safely,” Herzig said.

“Taken together, our findings really emphasize the importance of good communication between inpatient and outpatient providers,” Herzig said. “It’s important that primary care physicians know what medications their patients have been exposed to during hospitalizations. We hope this information will prompt hospitals to take a closer look at their own opioid-prescribing practices.

“Looking ahead, a better understanding of the predictors of opioid-related adverse events in hospitalized patients might enable institutions to take steps to make these medications safer during hospital use.”